A semi-biased commentary on British and American politics, culture and current affairs

Instituting a new feature on this blog, highlighting those rare, brave souls who dare to stick their heads above the parapet and suggest that Our Blessed NHS (genuflect) is no longer a sustainable model for delivering top quality healthcare to the British people

In a tax-funded health care system, the normal, self-limiting rules of supply and demand don’t apply. Where the service is perceived to be essentially “free”, demand can never be sated; it will just keep on growing until it breaks the system.

Three new elements have entered the equation in recent years to make an already grave situation much worse. One is the advent of mass communications. As people become more aware of potential threats to their health, and what treatments might be available to counteract them, they expect better and demand more.

Second, society is ageing. Most health care costs are incurred in the latter stages of life. Current demographics are delivering a double blow; more people are both moving into the high cost cohorts, and once in, they are surviving much longer than they used to.

And finally, there is the ceaseless march of technology, including the advent of “personalised medicine”, procedures and or treatments tailored specifically to the patient’s individual genome. Over time, this approach to medicine ought to become cheaper. It also already promises to make some existing and extremely expensive, treatments obsolete. But right now, it only piles on the costs. A personalised service is also quite alien to the NHS’s culture of uniformity. Even applying it will require radical change, never mind the small matter of how to pay for it.

Warner concludes, hopefully:

If the NHS was ever the “envy of the world” described by popular myth, it has long since ceased to be so. None of this is to denigrate those who work selflessly against the odds in British health care for the betterment of the UK public. It is merely to point out that the post-war model of funding no longer works and needs a radical overhaul. It would be a brave Prime Minister who questioned this sacred cow, but with meaningful Labour Party opposition all but vanished and the challenges and opportunities of Brexit likely to force change across the policy landscape, there could scarcely be a better time for some radical thinking than now.

This blog has no such optimism. Theresa May has earned her reputation as a somewhat traditionalist authoritarian for a good reason. She is already making noises about opening more grammar schools, thus establishing the new prime minister as a reinforcer of traditions rather than a slayer of sacred cows.

And the NHS, having passed its 68th birthday, is not just a British tradition – it is the British tradition, more integral to who we think we are as a people than Wimbledon, red telephone boxes or the Queen. You will see the monarchy abolished in this land before you see a system of private healthcare replace Our Precious NHS, at least under this government.

More to the point, Theresa May’s government already has its semi-competent hands full coming to terms with the scale of the challenge presented by Brexit. Unlike some of the cowboys in Vote Leave or Leave.EU, this blog never pretended that Brexit would be easy, and Theresa May’s Foreign Secretary and ministers for trade and leaving the EU are just now beginning to realise this fact.

Successfully negotiating the scoping of Britain’s negotiating position and then managing the initial two-year secession negotiations following the triggering of Article 50 will, whether Theresa May likes it or not, expend just about all of the political energy and capital that her government possesses this side of a general election, even if the Labour Party manages to continue being a slow-motion car crash right through til 2020. There simply will not be enough energy left for the fundamental restructuring of British healthcare, especially in the face of howling opposition from the NHS Industrial Complex, that vast web of vested interests which grows around the world’s fifth-largest employer like ivy on a crumbling building.

Neither has Theresa May shown any great interest in touching the super-charged third rail of British politics in any case. She kept Jeremy Hunt on in his role as Health Secretary, hardly a bold marker of intent to pursue a radically different course of action. Neither does a parsing of May’s past speeches reveal a yearning desire to enact healthcare reform bubbling beneath the cold, authoritarian exterior.

After the 2020 general election and in a post-Brexit environment, things may be different. This blog sincerely hopes that this is so – that Britain, buoyed by the fact that Brexit has (hopefully) been achieved without ushering in the apocalypse, might be in the mood to tackle other big challenges. But here we are on extremely flimsy ground – when nobody can comfortably predict the next month in British politics, it is foolish to daydream about what might possibly happen in four years’ time.

Yet everything that Jeremy Warner writes is true. At best, any government – even an NHS-worshipping Labour government under Jeremy Corbyn- could only paper over the cracks in our healthcare system. Relative performance on key metrics (like cancer survival rates) will continue to drift downwards, further away from our continental rivals, while NHS cheerleaders continue to point to value for money studies which suggest, on paper, that their idol is still the “envy of the world”. And the British people will continue to heap unending, unthinking praise on the NHS, literally killing themselves with their devotion to that giant bureaucracy.

It would nice to be able to write something more optimistic, but at this time there are absolutely zero grounds to expect that the situation will change for the better, short of a major crisis or unexpected political shock.

2 thoughts on “NHS Heresy, Part 1”

PBC1963August 24, 2016 / 2:39 PM

I sometimes refer to the NHS as “the last great uncorrected error of the Attlee Government.” Yet rather than correct it there seems at the moment to be a greater head of steam to repeat one of the errors by renationalising the railways – OK, I agree that nationalisation is an error that has never been properly corrected but you get my point.

I think you are right that the flow of information about how other systems perform better than the UK on key metrics such as cancer survival should help in the medium term. But in the short term the response will inevitably just be the call for even more funding.

We probably need a gradual process, starting with things that might command some public support. Just as optical and dental treatment appear to have been generally accepted as being as much, if not more, privately than publicly funded, other treatments that are of a lifestyle rather than medical need should be hived out of the NHS – artificial conception programmes for example. And of course those who want treatment for self inflicted problems should be wholly denied, in the case of tattoo removal, or charged a penal rate in the case of drunks.

The market may start to mitigate the problem even without a perceived political attack on the NHS. We are now seeing the emergence of online doctor services, utilising Skype and diagnostic technology generally, providing worldwide accessibility to a UK doctor at a convenient time with prescriptions delivered to home or work and linked to health maintenance apps. This sort of thing will take-off and make the previous acceptance of the current, producer focused, inaccessible GP system seem like something from another era, which of course it is.

You make an interesting point, and I’m inclined to agree – as the failures of the NHS become more frequent and egregious, more and more people will look to solutions outside the government-funded, government-provided monolith. This is undoubtedly a good thing, but unfortunately we will still be stuck paying for the NHS with our taxes, even as more and more of us opt out of it whenever we can. And while the NHS might temporarily benefit from reduced demand as people escape from it wherever they can, ultimately we may all end up paying twice for healthcare. So I think that while we should absolutely encourage these market-based bypasses around the NHS, we still need to tackle what you rightly call the Attlee government’s last uncorrected error by directing tackling the NHS Industrial Complex and the idea of government as a provider of healthcare.